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Lorraine S Wallace,1 Randell K Wexler,1 Leon McDougle,1 W Frederick Miser,1 J David Haddox2,3 1Department of Family Medicine, the Ohio State University, Columbus, OH, USA; 2Health Policy, Purdue Pharma L.P., Stamford, CT, USA; 3Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA Background: Although psychometrically sound pain assessment tools are available, there is a paucity of research that comprehensively defines chronic pain from the perspective of patients. The purpose of this study was to examine the utility of a combination of qualitative methods (Photovoice, one-on-one interviews, and focus groups) in examining the daily experiences of primary care patients living with chronic pain. Methods: A sample of English-speaking primary care patients aged 30 years or older, who had been prescribed an opioid for long-term, noncancer pain management, participated in the study. Each patient took photographs that best reflected both his/her experiences with chronic pain and what he/she would like his/her life to be without chronic pain. Results: Patients submitted an average of 20.2±3.1 photographs (range =8–27 photographs). Analysis of one-on-one interviews illuminated five dominant themes: daily need for multiple medications, including opioids; difficulties climbing a flight of stairs; struggling to get out of bed in the morning; extreme challenges with participating in day-to-day life activities; and experiencing feelings of hopelessness and helplessness on a regular basis. Seven themes emerged from the focus groups: undesired effects/burdens of medications, loss of/striving for independence, effect on social interactions/relationships, pain effect on activities of daily living, constant search for convenience/a better situation, interactions with physicians, and frustration/depression with pain. Conclusion: The qualitative methods employed in this study provide deep insight into perceptions and experiences of patients living with chronic pain that is vital for informing future clinical interventions. Keywords: opioid, Photovoice, qualitative research

Lorraine S Wallace,1 Randell K Wexler,1 W Frederick Miser,1 Leon McDougle,1 J David Haddox2,3 1The Ohio State University, Department of Family Medicine, Columbus, OH, 2Purdue Pharma LP, One Stanford Forum, Stanford, CT, 3Tufts University School of Medicine, Department of Public Health and Community Medicine, Boston, MA, USA Background: Although there are screening tools to aid clinicians in assessing the risk of opioid misuse, an instrument to assess opioid-related knowledge is not currently available. The purpose of this study was to develop a content-valid, understandable, readable, and reliable Patient Opioid Education Measure (POEM). Methods: Using concept mapping, clinicians caring for patients with chronic pain participated in brainstorming, sorting, and rating need-to-know information for patients prescribed opioids. Concept mapping analyses identified seven clusters addressing knowledge and expectations associated with opioid use, including medicolegal issues, prescribing policies, safe use and handling, expected outcomes, side effects, pharmacology, and warnings. Results: The 49-item POEM was verbally administered to 83 patients (average age 51.3 ± 9.8 years, 77.1% female, 47.1% African American) taking opioids for chronic nonmalignant pain. Patients averaged in total 63.9% ± 14.3% (range 23%–91%) correct responses on the POEM. The POEM demonstrated substantial test-retest reliability (interclass correlation coefficient 0.87). The POEM had a mean readability Lexile (L) score of 805.9 ± 257.3 L (equivalent to approximately a US fifth grade reading level), with individual items ranging from 280 L to 1370 L. Conclusion: The POEM shows promise for rapidly identifying patients' opioid-related knowledge gaps and expectations. Correcting misunderstandings and gaps could result in safer use of opioids in a clinical care setting. Keywords: opioid, knowledge, pain, questionnaire

Background: African Americans (AA) are 1.8 times more likely to develop type 2 diabetes than non-Hispanic Whites. This increased diabetes risk has been linked to high rates of obesity and poor dietary habits; therefore, the purpose of this study is to identify how the nutrient intake profiles of AA adults differ by diabetes status.Methods: Dietary intakes of AA adults (aged > or =18 years; n=2,589) were examined from the 1999-2004 National Health and Nutrition Examination Survey. Individuals were stratified into three groups (normoglycemia, pre-diabetes, and diabetes) based on self-reported previous diagnosis, blood glucose and use of glucose-lowering medications. Dietary intakes were collected using 24-hour recalls; energy-adjusted nutrients intake were compared across diabetes status.Results: Risk for pre-diabetes was 4% higher for every one year increase in age, while the risk for diabetes was 7% higher. Those with diabetes consumed significantly less energy (P=.03) and significantly more energy-adjusted protein (P=.011) and dietary fiber (P<.001) compared to those with normal blood glucose. Mean consumption of carbohydrates were nearly two and a half times the estimated average requirement regardless of diabetes status. Individuals with diabetes had significantly higher intakes of several B-vitamins including thiamin, riboflavin, niacin, folate and B-6 compared to individuals who had normal blood glucose values.Conclusion: This study identifies opportunities for improvement in the dietary habits of African Americans and supports the development of culturally-appropriate diabetes prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

The Cook airway exchange catheter (CAEC) is a long, flexible, hollow tube designed to facilitate the exchange of an in situ endotracheal tube. The primary use of the CAEC had been as a tube exchanger in the critical care setting. The unique characteristics of this device led us to use and report the use of the CAEC in the anesthetic management of a morbidly obese patient with significant tracheal deviation secondary to an enlarged thyroid gland. The potential strategies that we considered in this case were (1) extubating the patient in a deep plane of anesthesia; (2) extubating conventionally, with the patient awake; and (3) extubating the patient awake, with a 'bridge' to full extubation. After carefully weighing the options, we decided to use the CAEC as a tool that would allow us, if the patient did well, to go forth to full extubation, or, if the patient's condition deteriorated, to return to reintubation, or even oxygen insufflation, which would create a 'bridge' to extubation. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic challenged bioethical principles of research and the ability of scientific and healthcare institutions to provide equitable care. How can geroscience adapt to build equity within research protocols to better serve minoritized and marginalized communities? What lessons can geroscience take from the COVID-19 pandemic and its response? Developing geroscience approaches that incorporate such knowledge, including vaccine distribution plans and coalition-building to improve vaccine confidence, may help to reduce health inequities., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: Recognizing that the voice delivering the message is as important as the information being shared, we examined vaccine perceptions and willingness to encourage patients to obtain COVID-19 vaccinations among Black and Hispanic healthcare providers., Methods: We conducted a cross-sectional, online survey of Black and Hispanic healthcare providers who were members of the National Medical Association (NMA), National Hispanic Medical Association (NHMA), and National Pharmaceutical Association (NPhA) between January 11 - March 3, 2021, shortly after emergency use authorization (EUA) for the Pfizer and Moderna COVID-19 vaccines. Three multivariable logistic regression models were used to determine factors associated with the willingness to encourage COVID-19 vaccination., Results: The analytic sample consisted of 542 fully completed surveys. Pharmacists reported intent to take the vaccine (75.0% "as soon as you can" vs 91.4% for MD/DOs; p<0.001) and encouraged patients to get vaccinated (78.6% vs 91.0% for MD/DOs; p = 0.01). Providers in a suburban practice location were less likely to recommend vaccines to patients (OR=0.43, 95%CI: 0.22-0.87) and personal family (OR=0.45, 95%CI: 0.22-0.92) compared to those practicing in urban areas. Providers over age 45 were also more likely to report intent to take the vaccine themselves as soon as it was available (OR=3.72, 95%CI: 1.30-10.64)., Conclusions: This is likely the first cross-sectional study in the United States demonstrating the substantial vaccine confidence among Black and Hispanic healthcare providers who serve minoritized communities that have borne the greatest risk of adverse COVID-related outcomes., Competing Interests: Conflict of Interest None declared., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students., Method: This study collected data from a convenience sample of Black U.S. medical students via an anonymous electronic questionnaire in August 2020 that was distributed through the Student National Medical Association and Organization of Student Representatives listservs and an author's social media accounts. It included questions on demographics, institutional responses to seminal race events, experiences of discrimination, and symptoms of depression. Path models were used to examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students., Results: Of the 750 students completing the survey, 733 (97.7%) were Black. Experiences of discrimination and a lack of institutional responses to seminal race events were associated with more depressive symptoms (b = 0.19, 95% CI: 0.11, 0.26; P < .001 and b = 0.12, 95% CI: 0.04, 0.20; P = .01). After controlling for gender and clinical diagnosis of depression or anxiety before medical school, there was a relationship between experiences of discrimination and institutional responses to seminal race events such that students who reported more experiences of discrimination were more likely to report that their institution did not respond to seminal race events (b = 0.41, 95% CI: 0.34, 0.48; P < .001). Experiences of discrimination moderated the relationship between institutional responses to seminal race events and depressive symptoms (i.e., the relationship between a lack of institutional responses to seminal race events and depressive symptoms was stronger among students who reported more frequent experiences of discrimination)., Conclusions: Institutions dedicated to supporting Black medical student wellness must be diligent in cultivating a culture intolerant of discrimination and deft in their responses to seminal race events in the larger culture., (Copyright © 2022 by the Association of American Medical Colleges.)

Collaborative research between the University School of Medicine Office of Diversity and Inclusion, Health Sciences Library and Department of African and African American Studies recently identified Dr. Charles Edgar Newsome as the institution's first African American physician graduate in 1893. Born May 25, 1856 in the town of Buffalo within Putnam County of Northwest Virginia, he served for 3 years and 6 months as a member of the Regimental Band of the United States Army 25th Infantry, also known as the Buffalo Soldiers, became Grand Master of the Grand United Order of Odd Fellows, and served communities of the state as a reverend, physician, and civic leader. Archival records and photographs uncover the remarkable life of Reverend Charles Edgar Newsome, MD, a hidden figure in history., (Copyright © 2020 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Introduction: African American (AA) women have reported hair maintenance as a barrier to regular exercise; however, to our knowledge, this study is the first to identify primary care provider thoughts, attitudes, beliefs, and knowledge regarding hair as a barrier to increased physical activity among AA females., Methods: A 13-question electronic survey was sent via email to 151 clinicians working within a department of family medicine's 8 ambulatory clinics within a large urban academic medical center., Results: A total of 62 primary care clinicians completed the survey, which is a response rate of 41%. The vast majority of respondents (95%) sometimes/often engage in discussions with AA female patients regarding physical activity. However, 76% of respondents have never included a hairstyling or maintenance assessment in that discussion and only 34% noted being comfortable discussing this topic. Among a list of potential barriers to exercise, hair maintenance/scalp perspiration was rarely endorsed as important by clinicians., Discussion: This study highlights a need for increased education among primary care providers regarding AA hair care and maintenance practices as a barrier to increased physical activity in AA women. If specific barriers to increasing healthy habits among AA women are to be addressed, there must be a baseline knowledge of hair care and maintenance barriers, an understanding of the strong influence of cultural norms and practices as it relates to physical activity and exercise, and an increased comfortability when engaging in difficult cross-cultural conversations to ultimately improve health outcomes in AA females., Competing Interests: Conflict of interest: none declared., (© Copyright 2019 by the American Board of Family Medicine.)

The relative lack of diversity in medicine is a rate limiting factor in efforts to eliminate health care disparities. Many medical schools struggle to matriculate student bodies that reflect the diversity of this country. Actively recruiting is one tactic to diversify a medical school's applicant pool, but in isolation is not enough. Our medical school admissions committee made a number of programmatic changes that contributed to our current compositional diversity that may be instructive to others. This report from the field on the experience of one U.S. medical school describes several admissions committee initiatives that can be undertaken to increase the yield of students from groups underrepresented in medicine who matriculate to medical school.

Problem: Implicit white race preference has been associated with discrimination in the education, criminal justice, and health care systems and could impede the entry of African Americans into the medical profession, where they and other minorities remain underrepresented. Little is known about implicit racial bias in medical school admissions committees., Approach: To measure implicit racial bias, all 140 members of the Ohio State University College of Medicine (OSUCOM) admissions committee took the black-white implicit association test (IAT) prior to the 2012-2013 cycle. Results were collated by gender and student versus faculty status. To record their impressions of the impact of the IAT on the admissions process, members took a survey at the end of the cycle, which 100 (71%) completed., Outcomes: All groups (men, women, students, faculty) displayed significant levels of implicit white preference; men (d = 0.697) and faculty (d = 0.820) had the largest bias measures (P < .001). Most survey respondents (67%) thought the IAT might be helpful in reducing bias, 48% were conscious of their individual results when interviewing candidates in the next cycle, and 21% reported knowledge of their IAT results impacted their admissions decisions in the subsequent cycle. The class that matriculated following the IAT exercise was the most diverse in OSUCOM's history at that time., Next Steps: Future directions include preceding and following the IAT with more robust reflection and education on unconscious bias. The authors join others in calling for an examination of bias at all levels of academic medicine.

Unlabelled: The National Postbaccalaureate Collaborative (NPBC) is a partnership of Postbaccalaureate Programs (PBPs) dedicated to helping promising college graduates from disadvantaged and underrepresented backgrounds get into and succeed in medical school. This study aims to determine long-term program outcomes by looking at PBP graduates, who are now practicing physicians, in terms of health care service to the poor and underserved and contribution to health care workforce diversity., Methods: We surveyed the PBP graduates and a randomly drawn sample of non-PBP graduates from the affiliated 10 medical schools stratified by the year of medical school graduation (1996-2002)., Results: The PBP graduates were more likely to be providing care in federally designated underserved areas and practicing in institutional settings that enable access to care for vulnerable populations., Conclusion: The NPBC graduates serve a critical role in providing access to care for underserved populations and serve as a source for health care workforce diversity.

There is a critical need for enhanced health-professions workforce diversity to drive excellence and to improve access to quality care for vulnerable and underserved populations. In the current higher education environment, post-baccalaureate premedical programs with a special focus on diversity, sustained through consistent institutional funding, may be an effective institutional strategy to promote greater health professions workforce diversity, particularly physician-workforce diversity. In 2014, 71 of the 200 programs (36%) in a national post-baccalaureate premedical programs data base identified themselves as having a special focus on groups underrepresented in medicine and/or on economically or educationally disadvantaged students. Three post-baccalaureate premedical programs with this focus are described in detail and current and future challenges and opportunities for post-baccalaureate premedical programs are discussed.

Responding to health and digital inequities among older African Americans, a customized web-based mobile health information intervention is being developed for this vulnerable group and their doctors as part of the Health Empowerment Technologies (HET) Project. The belief is an empowered patient-doctor relationship leads to more improved health outcomes than patient empowerment alone. Using health information technology to empower both older African Americans and their doctors by increasing health literacy and computer capacities of both is the major HET study aim. A focus group of older African American patients and one of their doctors yielded data to help build the HET. Thematic analysis of opinions and preferences about the content and structure of the HET revealed concordance and asymmetry among the patients and doctors. While challenges prevail in its construction, building this ethnicity-specific web-based health information technology presents the opportunity to integrate health information technology in clinical encounters for every patient.

This study sought to determine the academic and professional outcomes of medical school graduates who failed the United States Licensing Examination Step 1 on the first attempt. This retrospective cohort study was based on pooled data from 2,003 graduates of six Midwestern medical schools in the classes of 1997-2002. Demographic, academic, and career characteristics of graduates who failed Step 1 on the first attempt were compared to graduates who initially passed. Fifty medical school graduates (2.5 %) initially failed Step 1. Compared to graduates who initially passed Step 1, a higher proportion of graduates who initially failed Step 1 became primary care physicians (26/49 [53 %] vs. 766/1,870 [40.9 %]), were more likely at graduation to report intent to practice in underserved areas (28/50 [56 %] vs. 419/1,939 [ 21.6 %]), and more likely to take 5 or more years to graduate (11/50 [22.0 %] vs. 79/1,953 [4.0 %]). The relative risk of first attempt Step 1 failure for medical school graduates was 13.4 for African Americans, 7.4 for Latinos, 3.6 for matriculants >22 years of age, 3.2 for women, and 2.3 for first generation college graduates. The relative risk of not being specialty board certified for those graduates who initially failed Step 1 was 2.2. Our observations regarding characteristics of graduates in our study cohort who initially failed Step 1 can inform efforts by medical schools to identify and assist students who are at particular risk of failing Step 1.

Purpose: This article reports the educational outcomes of the newly developed CARE (Cultural Awareness and Respect Through Education) Columbus cultural competency training program., Methods: Questionnaires were administered to course participants, who completed the 3-hour CARE Columbus cultural competency training program from March 17, 2006, to April 18, 2008. A pilot work site implementation questionnaire was also sent to a smaller sample of participants who completed the course., Results: The CARE Columbus cultural competency training received an overall program rating of 4.5 on a 5-point scale. Sixty-three percent (379 of 601) of the participants completed the program questionnaires. In addition, 55% (33 of 60) of the pilot work site implementation questionnaires were completed., Conclusion: Initial evaluation of the CARE Columbus cultural competency training program appears to demonstrate its effectiveness in improving attitudes, knowledge, and skills. Expanded evaluation to include determination of how best to overcome work site implementation barriers is warranted. Future challenges include development of an optimal business plan to maintain sustainability and improve outreach of CARE Columbus and similar classroom style training programs.

Purpose: The authors sought to identify variables independently associated with full-time faculty appointment among recent medical graduates., Method: With institutional review board approval, the authors developed a database of individualized records for six midwestern medical schools' 1997-2002 graduates. Using multivariate logistic regression, they identified variables independently associated with full-time faculty appointment from among demographic, medical-school-related, and career-intention variables. They report adjusted odds ratios (ORs) and 95% confidence intervals (CIs)., Results: Of 1,965 graduates in the sample, 263 (13.4%) held full-time faculty appointments in 2007-2008, including 14.4% (123/853) of women graduates and 8.6% (17/198) of underrepresented minority (URM) graduates. Women (OR: 1.386; 95% CI: 1.023-1.878), MD/PhD program graduates (OR: 2.331; 95% CI: 1.160-4.683), and graduates who reported a career-setting preference for "full-time university faculty" on the Association of American Medical Colleges' Graduation Questionnaire (OR: 3.164; 95% CI: 2.231-4.486) were more likely to have a full-time faculty appointment. Graduates who chose family medicine (OR: 0.433; 95% CI: 0.231-0.811) and surgical specialties (OR: 0.497; 95% CI: 0.249-0.994) were less likely to have a full-time faculty appointment. URM race/ethnicity was not independently associated with full-time faculty appointment (OR: 0.788; 95% CI: 0.452-1.375)., Conclusions: Efforts to increase representation of women graduates in academic medicine seem to have met with greater success than efforts to increase representation of URM graduates. Greater participation of URM students in MD/PhD programs and in interventions during medical school that promote interest in academic medicine careers may increase URM graduates' representation in academic medicine.

Purpose: Behavior rating scales have often been used to evaluate home and classroom behavior for children suspected of attention-deficit/hyperactivity disorder (ADHD). However, there is concern related to the use of behavior rating scales because African American boys and girls are twice as likely to be identified with ADHD behaviors by some of these instruments. This article serves as a brief reference for effectively evaluating African American children for ADHD., Methods: A MEDLINE search of peer reviewed literature published from 1970 to 2009 was conducted concerning the diagnosis of ADHD in African American children., Results: The majority of ADHD-specific behavior rating scales have face validity based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnostic criteria. However, with few exceptions, developers of these instruments have failed to use national samples with significant numbers of ethnic minorities to ascertain that screening questions are in fact detecting equivalent behavioral abnormalities across cultures. Fortunately, efforts have been undertaken to validate and improve effectiveness of ADHD-specific behavior rating scales in ethnically diverse populations., Conclusion: There are data supporting the use of the Terry and Vanderbilt Attention-Deficit/Hyperactivity Disorder scales for diagnosing ADHD in African American children. Further studies to develop and validate ADHD-specific behavior rating scales for African American children are needed.

Purpose: Multiple publications describe short- term and intermediate outcomes of premedical postbaccalaureate programs (PBPs). However, the authors could find no control group studies reporting the service provided by graduates of PBPs to patients who are medically indigent (e.g., on Medicaid or uninsured) and/or poor. The authors explored the relationship between successful completion of a midwestern PBP and providing care for the underserved., Method: In 2008, the authors surveyed 1996-2002 graduates of The Ohio State University College of Medicine who had been in practice for at least one year about their current practice population. The authors compared two groups: (1) physicians who completed the PBP and (2) a stratified random control group of physicians who graduated from the same medical school, in the same graduating classes, but did not participate in the PBP., Results: The survey return rate was 70.9% (73/103). Findings suggest that PBP graduates were more likely to be practicing medicine in a federally designated underserved area (29.4% versus 5.1%, P < .009) or providing service where 40% or more of the patients were medically indigent or poor (67.6% versus 33.3%, P < .003). PBP graduates were also more likely to be volunteering their services to patients who were indigent (47.1% versus 10.3%, P < .001)., Conclusions: This is likely the first control group study demonstrating the increased likelihood of graduates of a PBP providing health care to patients who are medically indigent and/or poor.

BACKGROUND: Low rates of colorectal cancer (CRC) screening persist due to individual, provider and system level barriers. PURPOSE: To develop and obtain initial feedback about a CRC screening educational video from community members and medical professionals. METHODS: Focus groups of patients were conducted prior to the development of an educational video and focus groups of patients provided initial feedback about the developed CRC screening educational video. Medical personnel reviewed the video and made recommendations prior to final editing of the video. RESULTS: Patients identified CRC screening barriers and made suggestions about the information to include in the educational video. Their suggestions included using a healthcare provider to state the importance of completing CRC screening, demonstrate how to complete the fecal occult blood test, and that men and women from diverse ethnic groups and races could be included in the same video. Participants reviewed the developed video and mentioned that their suggestions were portrayed correctly, the video was culturally appropriate, and the information presented in the video was easy to understand. Medical personnel made suggestions on ways to improve the content and the delivery of the medical information prior to final editing of the video. DISCUSSION: Participants provided valuable information in the development of an educational video to improve patient knowledge and patient-provider communication about CRC screening. The educational video developed was based on the Protection Motivation Theory and addressed the colon cancer screening barriers identified in this mostly minority and low-income patient population. Future research will determine if CRC screening increases among patients who watch the educational video. TRANSLATION TO HEALTH EDUCATION PRACTICE: Educational videos can provide important information about CRC and CRC screening to average-risk adults.

Persistent, painful cervical lymphadenopathy associated with malaise that does not respond to oral antibiotics may be cat-scratch disease. This condition is challenging to treat and may require surgical intervention. We present a case report of an immunocompetent 47-year-old African-American woman who was diagnosed with cat-scratch disease and hospitalized after multiple outpatient evaluations for progressive, painful lymphadenopathy. This case report outlines the patient's treatment in the author's urban outpatient clinic followed by an inpatient hospital stay with surgical intervention. Although the reported incidence of cat-scratch disease is higher in whites, primary care physicians should include cat-scratch disease in their differential diagnosis for African-American patients with regional lymphadenopathy, which is a hallmark of the disease. In addition, primary care physicians should be familiar with the atypical presentations of cat-scratch disease and the broad differential diagnosis for regional lymphadenopathy, including sarcoidosis, which is more common in African Americans.

Purpose: The purpose of this article is to share the procedures used to strengthen the Medical Pathways (MEDPATH) premedical postbaccalaureate program (PBP) to increase the chances of its students successfully graduating from medical school in four years., Methods: Subjects included students who matriculated into medical school between 1991-1999 (N = 72) following successful completion of the 12-month MEDPATH premedical PBP. Students who had passed the USMLE Step 1 on the first attempt were defined as successful and were compared to those who did not pass on their first attempt. Programmatic changes were implemented based on these findings, and outcomes were evaluated., Results: There was a significant improvement in total MCAT scores between pre-2003 (PBP entry year) participants (Mn = 20.73, SD = 3.10, N = 117) and post-2003 (PBP entry year) participants (Mn = 25.27, SD = 2.96, N = 37) (t = 7.86, df = 152, p < 0.001). MEDPATH premedical PBP coursework grade-point averages improved from 3.48 to 3.67 over the same time intervals. Diversity of program participants was maintained., Conclusion: The enhanced MEDPATH premedical PBP appears to be producing underrepresented minority and disadvantaged medical students who are better prepared to succeed in medical school.

There continues to be a shortage of primary care physicians practicing within urban, Iower-socioeconomic and minority communities despite the fact that many of the 125 allopathic and 19 osteopathic medical schools are located within the affected urban cities. Recognizing a need to better train and recruit primary care physicians to serve in urban settings and provide care to those underserved. The Ohio State Department of Family Medicine established an Urban Family Medicine Residency Program headquartered in Near East Columbus, OH. Starting in 2003, the Urban Family Medicine Residency Program began training up to two residents each academic year. The mission, vision and (curriculum have attracted residency applicants and faculty who have displayed sincere interest and commitment to practicing in urban lower socioeconomic communities.

The evaluation of aftercare instructions given to patients suffering from hymenoptera sting anaphylaxis was the objective of the study. Part of this evaluation included asking the physicians questions to examine the knowledge on which they based their aftercare instructions. Survey questionnaires were completed by 124 of 174 (71%) physicians who worked in an emergency department or urgent care center. Fifty-eight percent of the physicians never provided written avoidance instructions, 24% provided or prescribed anaphylaxis ID bracelets, 44% referred all of their patients to an allergist for further evaluation, and 73% reported prescribing an Epi-pen or Ana-kit to all hymenoptera sting anaphylaxis victims. Twenty-four percent of physicians did not know where to obtain anaphylaxis identification bracelets. This survey demonstrates that a substantial number of physicians practicing emergency medicine are not providing appropriate aftercare instructions to patients, and substantiates the need for educational efforts to increase the awareness of physicians concerning the implications of hymenoptera allergy and the value of proper preventive measures.

The reported incidence of thyrotoxicosis during pregnancy ranges from 0.02% to 3.7%, with an average of 0.2%. Ectopic pregnancy occurs in 1 of 66 pregnancies in the United States. The signs and symptoms of thyrotoxicosis complicate the diagnosis and surgical management of an ectopic pregnancy. This is the first reported case of thyrotoxicosis complicated by an ectopic pregnancy. The patient presented with a surgical abdomen (in this case an ectopic pregnancy) coupled with thyrotoxicosis. The combination of prompt presurgical medical intervention and operative correction prevented the mortality associated with a ruptured tubal pregnancy and thyroid storm.